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Editorials |6 September 2016

Pioglitazone: An Addition to Our Toolbox for Patients With Diabetes and Nonalcoholic Steatohepatitis?

Eduardo Vilar-Gomez, MD, PhD; Leon A. Adams, MBBS, PhD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at www.annals.org on 21 June 2016.
  • From University of Seville, Seville, Spain, and University of Western Australia, Nedlands, Australia.

    Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1303.

    Requests for Single Reprints: Eduardo Vilar-Gomez, MD, PhD, Unit for the Clinical Management of Digestive Diseases, Virgen Macarena-Virgen del Rocio University Hospitals, Institute of Biomedicine, Ciberehd, University of Seville, Manuel Siurot Avenue, s/n, Seville, Spain; e-mail, eduardovilar2000@yahoo.com.

    Current Author Addresses: Dr. Vilar-Gomez: Unit for the Clinical Management of Digestive Diseases, Virgen Macarena-Virgen del Rocio University Hospitals, Institute of Biomedicine, Ciberehd, University of Seville, Manuel Siurot Avenue, s/n, Seville, Spain.

    Dr. Adams: School of Medicine and Pharmacology, University of Western Australia, M50, Nedlands, Western Australia 6009, Australia.

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Nonalcoholic fatty liver disease (NAFLD) is a growing global public health problem and is now recognized as the most common cause of chronic liver disease in the United States and other industrialized countries (1). The prevalence of NAFLD has increased in parallel with the dramatic increase in obesity and type 2 diabetes mellitus (T2DM), and it is now estimated to occur in more than 30% of the adult U.S. population (1). Although most patients with NAFLD have simple steatosis and a relatively benign clinical course, a smaller proportion develop nonalcoholic steatohepatitis (NASH), which may progress to cirrhosis and liver cancer and increases the risk for cardiovascular and chronic kidney disease (1). Moreover, the presence of NASH and significant fibrosis increases the likelihood of all-cause death, liver transplantation, and liver-related complications (2, 3). The presence of T2DM in patients with NASH is strongly associated with fibrosis severity and mortality risk (4). Therefore, patients with T2DM particularly need therapies that modify the natural history of NAFLD and NASH.
Currently, management of NASH is directed toward improving the metabolic parameters that may contribute to its pathogenesis, such as losing weight via lifestyle interventions, reducing insulin resistance, and improving diabetes control. Although weight loss of 5% or greater may improve NASH, most affected persons are unable to achieve or sustain this amount of weight loss. Thus, pharmacologic therapies targeting NASH would be welcome additions to the therapeutic toolbox (5).
Given that...
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Vilar-Gomez E, Adams LA. Pioglitazone: An Addition to Our Toolbox for Patients With Diabetes and Nonalcoholic Steatohepatitis?. Ann Intern Med. 2016;165:373–374. [Epub ahead of print 21 June 2016]. doi: 10.7326/M16-1303

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Published: Ann Intern Med. 2016;165(5):373-374.

DOI: 10.7326/M16-1303

Published at www.annals.org on 21 June 2016

©
2016 American College of Physicians
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